This Article Full Text Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anderson, A. S. Articles by Lang, R. M. Search for Related Content PubMed PubMed Citation Articles by Anderson, A. S. Articles by Lang, R. M.

(Circulation. 1996;93:187-188.)
© 1996 American Heart Association, Inc.

Articles

Carcinoid Heart Disease

Allen S. Anderson, MD; Daniel Krauss, MD; Claudia Korcarz, DVM; Roberto M. Lang, MD

From the Noninvasive Cardiac Imaging Laboratory, Section of Cardiology, Department of Medicine, University of Chicago (Ill).

Correspondence to Roberto M. Lang, MD, Director Cardiac Noninvasive Imaging Laboratory, University of Chicago, 5841 South Maryland Ave, MC 5084, Chicago, IL 60637. E-mail: rlang@medicine.bsd.uchicago.edu.

Key Words: Cardiovascular Images • heart disease • valves

	Introduction

 
A53-year-old Indian man developed watery diarrhea. He was treated for inflammatory bowel disease without improvement. Three months before admission, he developed lower extremity edema, which progressed to include massive scrotal edema as well as dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. An ECG (Fig 1) and chest radiograph (Fig 2) were performed. An upper gastrointestinal series and small bowel series were unrevealing. An abdominal computed tomography scan demonstrated the presence of multiple liver masses (Fig 3). A percutaneous fine-needle liver biopsy was performed and yielded the cells seen in Fig 4. A 24-hour urine collection for 5-hydroxyindoleacetic acid was markedly elevated at 871 µmol/d (normal, <200 µmol/d). Echocardiographic findings are summarized in Figs 5 and 6.

View larger version (122K): [in this window] [in a new window]   Figure 1. ECG revealing sinus tachycardia at 100 beats per minute, right bundle-branch block, right-axis deviation, and poor R-wave progression. In carcinoid heart disease, the low voltage also noted here has been associated with increased short-term mortality after valve replacement.1

View larger version (153K): [in this window] [in a new window]   Figure 2. Posteroanterior chest radiogram depicting an enlarged cardiac silhouette with increased pulmonary vascular markings and cephalization of flow, bibasilar pulmonary edema, and a left pleural effusion. The azygous vein and superior vena cava are distended.

View larger version (103K): [in this window] [in a new window]   Figure 3. Left. Computed tomography scan of the abdomen after the administration of oral and intravenous contrast media. Multiple low-attenuation, contrast-enhancing masses in the liver are noted, many of which are fluid filled. The largest mass measures 5x7 cm. There is no evidence of abdominal or retroperitoneal adenopathy. The spleen, pancreas, and . . . [Full Text of this Article]